Automated eligibility verification provides complete benefits in seconds.

With patients moving in and out of exchange plans and the pervasiveness of Medicare and Medicaid advantage plans, eligibility is no longer just a ‘Yes or No’ question. To prevent denials, your patient access staff needs an efficient way to get true levels of coverage before and after service.

Decrease eligibility denials.

EligibilityPlus™ automatically retrieves and combines data from payer portals and electronic eligibility (EDI 270/271) transactions to present the most complete benefit detail available. Accurate coverage is quickly identified from both commercial and government plans, including exchange plans.

The automated solution verifies pre-and-post service if patients that identify as self-pay qualify for commercial or Medicaid coverage. EligibilityPlus™ seamlessly integrates with most major health information systems, including Epic, Cerner, McKesson, Meditech, Allscripts and Artiva.


Recondo has dropped our denial rate in eligibility from 10% to 2% denials within a year. Thank you.”
— Janine Maines, Director of Revenue Cycle

Pullman Regional Hospital

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Comprehensive Eligibility Verification

Automatically retrieves benefits to present the most complete benefit detail so staff no longer spend countless hours searching for correct information.

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Automatic Recheck

Performs an eligibility and benefit recheck if certain demographic information is updated in the HIS, such as a new date of service.

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Real-Time Alerts

Idenifies accounts with demographic discrepancies or status exceptions and provides actionable guidance for staff.

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Account Tagging

Accounts can be tagged as to alert the end user that they need to verify true eligibility directly with the payer.

Related Resources

Want to be an HFMA MAP winner?

Three of our client organizations were awarded the esteemed HFMA MAP Award last year. See how EligibilityPlus™ supports your MAP achievement.

Bad Debt (AR-6)

Trending indicator of the effectiveness of collection efforts and financial counseling. Indicates organization’s ability to collect accounts and identify payer sources for those who cannot meet financial obligations.

Clean Claim Rate (CL-1)

Trending indicator of claims data as it impacts revenue cycle performance. Indicates quality of data collected and reported.

Days in Total Discharged Not Final Billed (PB-1)

Trending indicator of claims generation process. Indicates RC performance and can identify performance issues impacting cash flow.

Days in Final Billed Not Submitted to Payer (PB-2)

Trending indicator of claims generation and submission process. Indicates revenue cycle performance and can identify performance issues impacting cash flow.

Cash Collection as a Percentage of Net Patient Service Revenue (FM-2)

Trending indicator of revenue cycle ability to convert net patient services revenue to cash. Indicates fiscal integrity/financial health of the organization.

Case Mix Index (FM-5)

Trending indicator of patient acuity, clinical documentation and coding. Supports appropriate reimbursement for services performed and accurate clinical reporting.

Cost to Collect (FM-6)

Trending indicator of operational performance. Indicates the efficiency and productivity of revenue cycle process.

Percentage of Patient Schedule Occupied (PA-1)

Trending indicator of claims generation process. Indicates RC performance and can identify performance issues impacting cash flow.

Pre-Registration Rate (PA-2)

Trending indicator of claims generation and submission process. Indicates revenue cycle performance and can identify performance issues impacting cash flow.

See why the nation's top providers choose Recondo.

The cash flow improvements and cost savings have been very apparent. It’s much less expensive to automate claim status verification with Recondo than add staff.

Mary Wickersham

VP, Central Billing Office, Avera Health

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